Volunteer Application for Snow Shoveling
The Village of Hinsdale Snow Shoveling Referral Program provides Hinsdale residents who are over the age of 60 or who have a disability, with the names and contact information of volunteers willing to shovel snow. By participating in this program and providing contact information, residents wanting your assistance will be provided with a list of individuals willing to shovel snow in their area. The resident is responsible for contacting the volunteer and for making the scheduling arrangements. The volunteer is responsible for completing the snow shoveling or notifying the resident if they are unable to complete the work.
Contact Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Alternative Phone Number
Please enter a valid phone number.
Email
*
example@example.com
School
Birth Year
*
Availability
Availability
*
Mornings
Afternoon
Evenings
Whenever
Weekdays
Weekends
I am able to bring a shovel to assist with shoveling snow:
*
Yes
No
Transportation:
*
I have access to transportation.
I can assist with work within walking distance only.
Emergency Contact Info
Emergency Contact:
*
First Name
Last Name
Emergency Contact Phone Number:
*
Please enter a valid phone number.
Consent and Agreement
I hereby agree that I will indemnify and hold the Village of Hinsdale harmless of and from any and all claims that may be made by any person or organization for personal injury and property as a result of participation in this Snow Shoveling Referral Program.
*
Clear
Parental Consent - Parental or Guardian signature is required if the applicant is under age 18.
Clear
Submit
Should be Empty: